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NPI Code Detail

MEDICARE: MICHAEL P KOCH LIC SW

MEDICARE: MICHAEL P KOCH LIC SW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker5141MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861453714
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL P KOCH LIC SW
Provider Business Mailing Address
First Line : PO BOX 43
Second Line : MR 10809
City : MINNEAPOLIS
State : MN
Zip : 55440-0043
Country : US
Telephone Number : 612-262-1166
Fax Number : 612-262-9035
Provider Business Practice Location Address
First Line : 8611 W POINT DOUGLAS RD S
Second Line :
City : COTTAGE GROVE
State : MN
Zip : 55016-4005
Country : US
Telephone Number : 651-458-1884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2006
Last Update Date : 01/12/2023

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Directions to “ MICHAEL P KOCH LIC SW” Practice Location

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